Some contend surgeons are lounging
on their laurels.
No, say others, the nation's scalpels are in good hands

By Julia Cyboran

"It's difficult to talk about this
and be polite, but there's a certain reluctance to change
and move on from what's comfortable."It all started
with this quote. Dr Gopal Bhatnagar, Head of Cardiovascular
Surgery at Trillium Health Centre in London, Ontario,
went out on a limb and potentially set himself up for
a fall when he was asked for his opinion on a new surgical
technique called beating-heart surgery.

The quote ran in the Globe and
Mail on April 21 concerning the technique, with
no objection from Dr Bhatnagar, even though he knew
that some of his surgeon colleagues wouldn't be pleased
with the fiery accusation. His statement does beg the
question: Are Canadian surgeons really that complacent
when it comes to learning new skills?

Dr Bhatnagar doesn't like to point
fingers, but he does believe that some Canadian surgeons
are hesitant about changing with the times. He says
it wasn't his intention to attack his colleagues directly,
but to call attention to what he sees as a troubling
trend in the Canadian surgical community. He feels that
many surgeons work in a 'comfort zone.' "They want to
do what's best for the patient and they often perceive
what they do repeatedly as the safest," he says.

Some doctors in the field see things
differently. Dr Bob Litchfield, Educational Director
of the London-based Canadian Surgical Technologies &
Advanced Robotics (C-STAR), is one surgeon who believes
that Canada is a cut above the rest when keeping up
with evolving technologies. "We aren't complacent in
Canada," he says. "The motivating forces behind surgical
advances are different here. We don't have the market
forces that exist in the US. Here, we're doing what's
best for the patient."

Dr Litchfield does concede that
certain physicians are slower at jumping on the bandwagon.
"There tends to be people who jump on every new technique
and then there are those who sit back and wait," he
says.

Late adopters usually prefer to
wait for a prodigious pile of clinical data before taking
on a new technique, something that Dr Bhatnagar acknowledges
is an important step. "It's a matter of proof. For many
surgeons, studies need to be done over a long period
of time to convince them that the technique works,"
he says. "Every practitioner has to decide what the
burden of proof is for them. Some surgeons need to see
results from several randomized studies to know if something
is clear."

FRONTIER
SCALPEL SLINGERS
The reluctance of one group ? be they the majority or
not ? is counterbalanced by the vision of the others.
Innovative surgeons pave the way for new surgical techniques
? Dr Bhatnagar with beating-heart bypass surgery and
Dr Litchfield with minimally invasive techniques and
robotics.

Besides reluctance, one of the
things that can potentially put the brakes on skill
set progress is funding. "Money is going to be an issue
here in Canada," says Dr Bhatnagar. "Many of the minimally
invasive techniques use scopes, clips and other components
that cost a lot. In some ways the old techniques do
cost less, initially. But newer techniques will save
money in the long term ? less patient complications
will mean less expenditures."

This is one point on which Dr Litchfield
agrees with his colleague. "There is a saving in the
long term when we treat with less invasive techniques,"
he says. But Dr Litchfield notes that Canada has maintained
a position of being a world leader in new techniques
and technologies. "I think we have continued to be quite
fortunate because hospital administrators are responsive
to new techniques and up for better patient care."

In order to continue along this
path, the path of innovation needs to shift toward med
schools and students. Teachers' attitudes and openness,
as well as the students' receptiveness will dictate
how surgery will evolve. "When I went to med school
free thinking wasn't encouraged," explains Dr Bhatnagar.
"You had to memorize reams of information and you repeated
what you saw." Much of the future of a changing skill
set will depend on how surgery is taught. He adds that
educators should devise curricula that encourages students
to push the envelope.

Dr Litchfield, who incidentally
went to med school with Dr Bhatnagar, agrees. "We were
spoon-fed what was in text- books," he says. But he
does point to a change in attitudes in today's med schools.
"We're now teaching students to analyze the information
they're receiving. I think they are much better off
now."